Clinical Manifestation of

Ascariasis

RaveinalSub division Allergy Immunology Internal Medicine Andalas University / M Jamil Hospital Padang INTRODUCTION• Ascaris lumbricoides is the largest nematode (roundworm) parasitizing the human intestine.• Ascaris lumbricoides is an intestinal worm found in the small intestine of man.• They are more common in children then in adult.• As many as 500 to 5000 adult worms may inhabit a single host. Geographic Distribution

• The most common human helminthic

• It is a elongated, cylindrical and

tapering at both ends.• Sexes are separate• The female is longer than male 20 – 35 cm long, 4-6 mm in diameter.• Male is smaller being 15-30 cm long, 2-4 mm in diameter.• The posterior end of male is curved having penial setae near the end.Ova of Ascaris lumbricoides INFECTION TO MAN• It occurs when the man swallows the infective eggs of Ascaris with contaminated food or water.The Egg of Ascaris Immunology respon to helminth• Th2 activation  CD4 lymphosite to release IL4 and Il5• IL4  trigger B cell lymphosite to produce IgE• IL5  trigger of eosinophyl activation•LIFE CYCLE Life cycles1. Site of inhabitation: small intestine2. Infetive stage: embryonated eggs3. Route of infection: by mouth4. No intermediate and reservoir hosts5. Life span of the adult: about 1 year• This worm lives in the lumen of small intestine, feeding on the intestinal contents, where the fertilized female lays eggs.• An adult female can produce approximately 240,000 eggs per day, which are passed in feces.• The eggs are development of about three weeks until a motile embryo is formed within the egg.• Unfertilized eggs may be ingested but are not infective. Fertile eggs embryonate and become infective after 18 days to several weeks.

• After infective eggs are swallowed , the

larvae hatch , invade the intestinal mucosa.

• Carried via the portal, then systemic

circulation to the lungs. larvae mature further in the lungs (10 to 14 days), penetrate the alveolar walls, ascend the bronchial tree to the throat, and are swallowed.• Upon reaching the small intestine, they develop into adult worms. Between 2 and 3 months are required from ingestion of the infective eggs to oviposition by the adult female. Adult worms can live 1 to 2 years. Rhabditiform larvae

• Restlessness• Disturbed sleep• Worm in stool• Worm in vomit CLINICAL FEATURES• Abdominal pain, diarrhoea, vomiting and slight temperature.• It blocks intestine and appendix.• They may enter bile or pancreatic duct and interfere with digestion.• Injure the intestine and cause peritonitis.• They produce toxins which irritate the mucous membrane of the gut, or prevent digestion of protein by host by destroying an enzyme trypsin.• In children they cause stunted growth and makes the mental capacity dull.• Larvae causes inflammation and haemorrhage in the lungs which results in pneumonia – may prove fatal. Iii. DiagnosisThe symptoms and signs are for reference only. The confirmative diagnosis depends on the recovery and identification of the worm or its egg.1. Ascaris pneumonitis: examination of sputum for Ascaris larvae is sometimes successful.2. Intestinal ascariasis: feces are examined for the ascaris eggs.2. Intestinal ascariasis: feces are examined for the ascaris eggs.

- direct fecal film: it is simple and effective.

The eggs are easily found using this way due to a large number of the female oviposition, approximately 240,000 eggs per worm per day. So this method is the first choice.

-recovery of adult worms: when adults or

adolescents are found in feces or vomit and tissues and organs from the human infected with ascarids , the diagnosis may be defined Treatment• Infections with A.lumbricoides are easily treated with a number of anthelmintic drugs:• pyrantel pamoate given as a single dose of 10 mg/kg.• levamisole given as a single dose of 2.5 mg/kg.• mebendazole given as a single dose of 500 mg.• albendazole given as a single dose of 400 mg. PREVENTION• Keeping good sanitation conditions is the only way to prevent the infection of Ascaris.• Pollution of soil with human faeces should be avoided.• Vegetable should be thoroughly washed in a mild solution of Pottasium permanganate and properly cooked before use.• Finger nails should be regularly cut to avoid the collection of dirt and eggs below them.• Hands should be properly washed with some antiseptic soap before touching edibles or eating.THANK YOU